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This is VAERS ID 283501

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 283501 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Foreign  
   Days after vaccination:24
Submitted: 2007-06-29
   Days after onset:213
Entered: 2007-07-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Crying, Death, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Diarrhoea; Malnutrition
Diagnostic Lab Data: None
CDC Split Type: WAES0706CRI00010

Write-up: Information has been received from a health professional concerning a 4 month old female with a history of diarrhoea and malnutrition who on 03-NOV-2006 was vaccinated with Rotateq. There was no concomitant medication. On approximately 27-NOV-2006 the patient experienced intussusception, crying, hematochezia and vomiting and was hospitalized. The reporter felt that intussusception, crying, hematochezia and vomiting were not related to therapy with Rotateq. Patient died on 27-NOV-06. Additional information is not expected.

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